Pediatricians Call For Universal Depression Screening For Teens

Feb 26, 2018
Originally published on February 26, 2018 5:11 pm

Only about 50 percent of adolescents with depression get diagnosed before reaching adulthood. And as many as 2 in 3 depressed teens don't get the care that could help them.

"It's a huge problem," says Dr. Rachel Zuckerbrot, a board-certified child and adolescent psychiatrist and associate professor at Columbia University.

To address this divide, the American Academy of Pediatrics has issued updated guidelines this week that call for universal screening for depression.

"What we're endorsing is that everyone, 12 and up, be screened ... at least once a year," Zuckerbrot says. The screening, she says, could be done during a well-visit, a sports' physical or during another office visit.

Zuckerbrot helped write the guidelines, which have been in development for a while. The U.S. Preventive Services Task Force also recommends depression screening, and many pediatricians have already woven the screenings into their practices.

"Teenagers are often more honest when they're not looking somebody in the face who's asking questions," about their emotional health Zuckerbrot says. So, most pediatricians use a self-reported questionnaire that teens fill out themselves, either on an electronic device or on paper.

"It's an opportunity for the adolescent to answer questions about themselves privately," she says.

The questionnaires contain a range of questions. For instance, one version, asks: 'Over the past two weeks, how often have you been bothered by any of the following problems: feeling down, depressed or hopeless? Or, little interest or pleasure in doing things?' Teens are also asked questions such as, 'Are you having difficulty with sleep, either too much or too little?' 'Any problems with eating?'

The new recommendations also call for families with a depressed teen to develop a safety plan to restrict the young person's access to lethal means of harm. Suicide is a leading cause of death for children aged 10 to 17, and "adolescent suicide risk is strongly associated with firearm availability," according to an AAP report.

There's growing awareness in the U.S. of the need for young people to have good access to mental health care, says Dr. Doug Newton, a child psychiatrist at Kaiser Permanente in Colorado. "As a nation this has become part of the dialogue; it increasing"

"People are aware of what's happening in our schools and the importance of mental health," Newton says. Kaiser Permanente has a stigma-reduction campaign called Find Your Words.

"Stigma is a huge challenge," he says, "specifically for adolescents. Often times they're not coming in to get help because of the stigma attached."

It's not easy to talk about depression, yet the problem is fairly common. During the teenage years, there's about a 20 percent [chance] of having depression or anxiety, research suggests.

"It's highly prevalent," Newton says. The goal of the "Find Your Words" campaign is to help make depression easier for everyone to talk about.

Another challenge to diagnosis is that families often don't detect depression, or they confuse it for something else.

"Sometimes teens are acting out or misbehaving," Zuckerbrot says. They're seen as being hostile or bad. "When, instead, they're really suffering from depression."

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As any parent of a teenager can tell you, teens can be moody at the best of times. So how can you tell if something more serious is actually going on? The American Academy of Pediatrics is today releasing new guidelines aimed at flagging and treating teen depression. NPR's Allison Aubrey reports that as many as 1 in 5 teens experience bouts of depression, but many do not get help.

ALLISON AUBREY, BYLINE: It's not uncommon for teenagers to withdraw from their parents, to cut them out of communication. And sometimes, parents don't want to pry. Adolescent psychiatrist Rachel Zuckerbrot says this dynamic is one reason teen depression can go undetected.

RACHEL ZUCKERBROT: So often people are suffering on the inside, but it might not be obvious on the outside. And sometimes it gets misdiagnosed because sometimes teenagers who are depressed are actually acting out and misbehaving, and instead, they are looked at as being hostile or bad when in fact they're really suffering from depression.

AUBREY: Zuckerbrot says this is a problem. She's an associate professor of clinical psychiatry at Columbia.

ZUCKERBROT: Most teenagers with depression don't get access to mental health care. In fact, about 50 percent of teenagers don't even get diagnosed.

AUBREY: To address this, the American Academy of Pediatrics' new guidelines call for universal screening for teen depression.

ZUCKERBROT: What we're endorsing is that everyone who is 12 and up be given, at least once a year for their school physicals or their sports physicals, a depression screen that is a self-report questionnaire.

AUBREY: Zuckerbrot helped write the new guidelines, which have been in the works for a while. She says teens tend to be more honest when they're not face to face with an adult asking questions. So they can fill out the questionnaires in private.

ZUCKERBROT: These questionnaires ask about whether they've been sad and irritable. They ask about whether things that used to be interesting to them are now boring. They ask if they're having difficulty with sleep, either too much sleep or too little sleep.

AUBREY: The recommendations also call for families with a depressed teen to come up with a safety plan.

ZUCKERBROT: We do want to make sure as part of safety planning that firearms are locked up, that alcohol is either put away and locked up or gotten rid of.

AUBREY: Zuckerbrot says families also need to know where to go.

ZUCKERBROT: Parents go to their pediatrician for vaccinations, for a high fever but don't realize that when there are emotional problems or behavioral problems that their pediatrician is going to be an excellent resource.

AUBREY: And often the best place to start. Allison Aubrey, NPR News. Transcript provided by NPR, Copyright NPR.